Declining incidence of hepatitis C related hepatocellular carcinoma in the era of interferon-free therapies: a population-based cohort study

Hamish A. Innes, Scott A. McDonald, Victoria Hamill, Alan Yeung, John F Dillon, Peter Clive Hayes, April Went, Andrew Fraser, Andrew J Bathgate, Stephen T. Barclay, Naveed Z Janjua, David J Goldberg, Sharon J. Hutchinson

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

The impact of interferon (IFN)-free therapies on the epidemiology of hepatitis C virus (HCV) related hepatocellular carcinoma (HCC) is not well understood at a population level. Our goal was to bridge this evidence gap.
This study included all patients in Scotland with chronic HCV and a diagnosis of cirrhosis during 1999-2019. Incident cases of HCC, episodes of curative HCC therapy, and HCC-related deaths were identified through linkage to nationwide registries. Three time periods were examined: 1999-2010 (pegylated interferon-ribavirin [PIR]); 2011-2013 (First-generation DAA); and 2014-2019 (IFN-free era). We used regression modelling to determine time trends for: i) number diagnosed and living with HCV cirrhosis, ii) HCC cumulative incidence, iii) HCC curative treatment uptake and iv) post-HCC mortality.
3347 cirrhosis patients were identified of which 381 (11.4%) developed HCC. After HCC diagnosis, 140 (36.7%) received curative HCC treatment and there were 202 deaths from HCC. The average annual number of patients diagnosed and living with HCV cirrhosis was approximately seven times higher in the IFN-free versus the PIR era, whereas the number of incident HCCs was four times higher. However, the cumulative incidence of HCC was significantly lower in the IFN-free versus PIR era (sdHR: 0.65; 95%CI:0.47-0.88; P=0.006). Among HCC patients, diagnosis in the IFN-free era was not associated with improved uptake of curative treatment (aOR:1.18; 95%CI:0.69-2.01; P=0.54), or reduced post-HCC mortality (sdHR: 0.74; 95%CI:0.53-1.05; P=0.09).
The cumulative incidence of HCC is declining in HCV cirrhosis patients, but uptake of curative HCC therapy and post-HCC survival remain suboptimal.
Individuals with hepatitis C cirrhosis are at high risk of developing hepatocellular carcinoma (HCC), which is the main form of primary liver cancer. Here, we shown that the incidence of hepatitis C related HCC has declined in recent years, following the introduction of new hepatitis C therapies. However, for individuals who do develop HCC, survival and uptake of curative treatment still remains poor.
Original languageEnglish
Pages (from-to)561-574
Number of pages14
JournalLiver International
Issue number3
Early online date5 Jan 2022
Publication statusPublished - 22 Feb 2022


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